Nursing Care of the Older

Adult in Wellness
 Health promotion of the elderly

 Health promotion is the process of enabling

people to increase control over & improve
their health by developing their resources to
maintain or enhance well being.
 Health promoting is an action for health
using knowledge, communication &
understanding
 Component of
health promotion
1. Exercise
2. Nutrition
3. Rest & sleep
4. Periodic medical check up
5. High risk behavior
6. Spiritual well-being
7. Psychosocial well-being
1- Exercise

Psychological

Benefits of
exercise
Physical Social
 Physical benefits of exercise

1) Consumption of body fat

2) Improve cardio-vascular capacity( by↑ blood flow----- keep
tissue healthy
3) Control hypertension& blood sugar
4) Improve respiratory function
5) Improve joint flexibility
6) Improve pattern of sleep & rest
7) ↑ independency
8) Improve sense of well –being & relaxation
9) Maintain mind’s function
10) Promote sense of normality
11) Peristaltic movement
 Psychological benefits of
exercise

1. Improve mood state

2. Improve self-image
3. Reduce stress
4. Enhance sleep
5. Improve depressive state of
elderly
Social benefits of exercise

 Improve social interaction & relation with other

Role of the nurse during exercise

I- Assessment done at the beginning of exercise program

include:
1. History & physical examination (CVS, resp,
musculoskeletal & neurological system)
2. Renal & liver function tests
3. ECG,& exercise stress test
4. Assess range of motion & use of assistive devices.
5. Assess environmental hazards
II-Set a regular time to exercise each day
III- Before starting exercise the nurse
should advice the elderly about:

1. Document baseline resting function status (ht &resp rate,

bl.sugar)
2. 10 minutes warms up stretching exercise
3. Drink water before and after exercise is important as water
will be lost during exercise
4. Clothes worn during exercise should allow for easy
movement and perspiration.
5. Athletic shoes provide both support and protection
6. Outdoor exercise should be avoided in extremely hot or
cold weather.
 During exercise
 Monitor heart & resp. rate
 Stopexercise if elderly has fatigue , chest
pain or ↑heart & resp. rate
After exercise:
 10 minutes cooling up at end of exercise
 Monitor pulse rate during cooling for
returning to resting ht. rate
2- Nutrition
It is neglected especially those
living alone or with low income.
Factors affecting nutritional status:
1) Age related changes
2) Psychosocial factors
3) Economic factors
4) Cultural factors
Age related changes
 ↓ Taste & smell
 ↓ Visual acuity
 Loss of teeth & poor fitting denture
 ↓ Gastric secretion→ influence in absorption
of B12, folic acid& iron.
Food remain longer time in stomach + ↓ gastric secretion
will lead to indigestion &feeling of fullness.
 Psychosocial factors
 Depression is common ( losses, death,
retirement, change of body appearance,
impaired vision &poor physical fitness) this
will lead to lack of interest in eating&
anorexia and ↓ food intake.
 Living alone also will lead to lack of
incentive to cook &eat.
Economic Factors
 Low income
 Limited access to food and food
choices
 Inadequate facilities to food storage
and preparation
 Cultural factors

Eating habits may miss certain

food group as vegetarians.
 Fluid intake
Elderly at high risk for dehydration due to:
 ↓ Thirst sensation
 Inadequate fluid intake (2000-3000 cc/day)
required
 Some medications, such as for high blood
pressure or anti-depressants, and diuretic
 Some medications may cause patients to sweat
more
 Frail seniors have a harder time getting up to
get a drink when they’re thirsty, or they rely on
caregivers who can’t sense that they need fluids
 As we age our bodies lose kidney function and
are less able to conserve fluid (this is
progressive from around the age of 50, but
becomes more acute and noticeable over the age
of 70)
 Illness, especially one that causes vomiting
and/or diarrhea, also can cause elderly
dehydration
 Nurse Role
 Assessment involves: nutritional history,
physical examination, anthropometric
measurements, biochemical evaluation,
cognitive & mood evaluation
 Health history related to nutrition
 Anthropometric measurement
 Client and family education
Dietary guideline for old persons

 Eat a variety of food

 Maintain a healthy wt
 Choose a diet low in fat, saturated &
cholesterol
 Choose a diet plenty of vegetables, fruits &
grain products
 Use sugar & salts in moderate
 Drink 200-3000cc/daily
 3- Rest& sleep

 Person spend 1/3 of his life in sleep

 Sleep is time for cell growth& repair
 Elderly need 5-7 hrs at night
Importance of Rest& sleep:
 Conserve energy
 Provide organ respite (rest)
 Restore the mental alertness& neurological
efficiency
 Relieve tension
 Emerge feeling of well being
 Nursing measures adopted
to promote sleep
1. Engage in exercise program
2. Avoid exercise within 3-4 hr. of bedtime.
3. Spend time out door in the sunlight each
day but avoid period between 12 Md to 3
PM sunshine exposure.
4. Engage in relaxing activities near
bedtime.
5. Avoid tobacco at bedtime
6. Avoid drink any caffeinated beverages
before mid afternoon.
7. Limit fluid intake after the dinner hour if
nocturia is a problem.
8. Limit daytime naps to 30 minutes or less.
9. Avoid using the bed for watching TV,
writing bills, and reading.
 4- Periodic medical
examination
Importance of Periodic medical examination:
1. Assess elderly level of well-being
2. Detect early signs of disease
3. Educate client how to promote his health
4. Reinforce + ve promoting & protecting
behaviors
5. If examination done at home, it permit
evaluation of environment ( hazards care
giver…)
Types of health screening

Health screening Period

Bl. p Each Dr. visit or 3-6 months

Ht & wt Periodically as part of

comprehensive physical
examination
Dental check up Once / year( annually)
Fecal occult blood& ( annually)
sigmoidoscopy
Vision including glaucoma test Every 2 years
 Health screening Period
Hearing Evaluate periodically
Cholesterol level Every 5 years
Cancer screening Annually
Mammography for 1-2 years
women under 70 y
Digital rectal examination Annually
Immunizations

Vaccination Period
Influenza (over 65y) Annually (mid October to
mid November)
Tetanus & diphtheria Every 10 years
Pneumococcal Once at age 65y,
vaccination revaccination for high risk
fatal pneumonia/6 y
 6- Spiritual Well- being

 Spiritual
well-being is a state in which
the positive aspects of spirituality are
experienced, incorporated and lived
by the individual and reflected into
ones environment.
Signs of spiritual distress:
 Doubt
 Despair
 Guilt
 Boredom
 Expression of anger toward god
Benefits that people experience from
spiritual wellbeing counseling and
groups

 A feeling of being more contented with their

life’s situation
 Greater enjoyment of self time, finding an inner
peace
 Greater ability to take control of and resolve
their life’s issues
 A greater sense of satisfaction in their activities
and life situations
 Ability to take a more active part in life
rather than standing still and watching it
pass by
 Ability to build more intimate, loving and
lasting relationships
 A greater feeling of purpose and meaning in
their life
7- Psychosocial Well- being

Psychosocial changes may alter an individual relationship with others.

Physical wellbeing depend on:
 Psychosocial wellbeing
 Social structure
 Personal relationships
In Later years many adjustment are
necessary
 Role of the nurse in
health promotion
 Assessment to his physical health, Psychosocial
Well- being, lifestyle pattern, hobbies, high risk
behaviors, knowledge, believes& attitudes that
affect health & wellbeing.
 Assess health needs
 Assess social , environmental & cultural influences
on health behaviors
 Lifestyle modifications is a comprehensive
approach for effective change in heath
promotion behaviors
 Nurse role should be directed toward helping elderly to
cope with his function level ------delay disabilities &
impairments.
 Nurse identify environmental hazards & make
necessary modifications
 Identify social needs & encourage participation &
social support groups.
 Nurse should inform elderly & caregivers about aging
process, common disorders & disabilities , different
services available
 Encourage elderly to take better
care to them, avoid high risk
behaviors,& hazards affecting
their health.
 Regular and continuous
evaluation is important aspect of
nurse’s role.